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Valoración Precoz de la Disnea en la Insuficiencia Cardiaca Aguda: Características del Paciente y Diferencias de Respuesta entre las Escalas Likert y las Escalas Visuales Analógicas
Author(s) -
Pang Peter S.,
Collins Sean P.,
Sauser Kori,
Andrei AdinCristian,
Storrow Alan B.,
Hollander Judd E.,
Tavares Miguel,
Spinar Jindrich,
Macarie Cezar,
Raev Dimitar,
Nowak Richard,
Gheorghiade Mihai,
Mebazaa Alexandre
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12390
Subject(s) - medicine , likert scale , visual analogue scale , heart failure , emergency department , observational study , physical therapy , clinical endpoint , emergency medicine , cardiology , intensive care medicine , randomized controlled trial , statistics , mathematics , psychiatry
Abstract Background Dyspnea is the most common symptom in acute heart failure ( AHF ), yet how to best measure it has not been well defined. Prior studies demonstrate differences in dyspnea improvement across various measurement scales, yet these studies typically enroll patients well after the emergency department (ED) phase of management. Objectives The aim of this study was to determine predictors of early dyspnea improvement for three different, commonly used dyspnea scales (i.e., five‐point absolute Likert scale, 10‐cm visual analog scale [ VAS ], or seven‐point relative Likert scale). Methods This was a post hoc analysis of URGENT Dyspnea, an observational study of 776 patients in 17 countries enrolled within 1 hour of first physician encounter. Inclusion criteria were broad to reflect real‐world clinical practice. Prior literature informed the a priori definition of clinically significant dyspnea improvement. Resampling‐based multivariable models were created to determine patient characteristics significantly associated with dyspnea improvement. Results Of the 524 AHF patients, approximately 40% of patients did not report substantial dyspnea improvement within the first 6 hours. Baseline characteristics were similar between those who did or did not improve, although there were differences in history of heart failure, coronary artery disease, and initial systolic blood pressure. For those who did improve, patient characteristics differed across all three scales, with the exception of baseline dyspnea severity for the VAS and five‐point Likert scale (c‐index ranged from 0.708 to 0.831 for each scale). Conclusions Predictors of early dyspnea improvement differ from scale to scale, with the exception of baseline dyspnea. Attempts to use one scale to capture the entirety of the dyspnea symptom may be insufficient.